Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT2067 | ME |
NPI | 1386874238 |
---|---|
Provider Name | Heidi Marie Kelly |
First Address | Augusta, ME 04330 |
Second Address | Augusta, ME 04330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2009 |
Last Update Date | 24/07/2009 |